Prostate cancer modeling data can guide screening decisions in high-risk patients
In the absence of clinical trial evidence, modeling data can be used to evaluate the benefit of screening while reducing the burden of over-detecting prostate cancer.
Patients at highest risk for prostate cancer include Black Americans and Caribbean males, individuals with a strong family history of prostate cancer, such as a father or brother diagnosed with the disease, and carriers of rare genetic variants, such as BRCA 1/2, HOXB13 and Lynch syndrome. These patients can carry a risk of prostate cancer that is twice as high as, if not higher than, the general population. Limited high-quality evidence, such as randomized controlled trials, exists to inform best screening practices in these populations. This is especially true regarding strategies aimed to reduce the harms of prostate cancer screening.
“Among high-risk populations, we have the least amount of high-level evidence to support informed decision-making around PSA [prostate-specific antigen] screening,” said Yaw A. Nyame, MD, assistant professor in the department of urology at the University of Washington School of Medicine in Seattle. In the absence of adequate screening trial data, Dr. Nyame will present data from prostate cancer microsimulation models developed by the Cancer Intervention and Surveillance Modeling Network (CISNET) Prostate Working Group, led by Ruth Etzioni, during the plenary session, “State-of-the-Art Lecture: Prostate Cancer Screening in High-Risk Groups,” on Friday, May 3, at AUA2024 in San Antonio.
The CISNET Prostate Working Group applies a unique interdisciplinary approach that combines available data with modern statistical techniques to understand the long-term effects of PSA screening and other interventions.
“Among high-risk populations, there are more cancers. With intensified screening of high-risk groups starting at younger ages, we have the potential to increase the detection of individuals who harbor more aggressive cancer earlier. But without an intermediate step to help us determine who may truly harbor clinically significant cancers, we also have the potential to increase the diagnosis of low-risk cancer among high-risk populations,” said Dr. Nyame, who is a CISNET co-investigator.
“So far, we’re seeing from CISNET modeling data … that MRI has the potential to play a big role for informed decision-making in selecting patients with elevated PSA for biopsy,” he said. “MRI presents an opportunity to reduce over-detection among high-risk screened populations. It may provide additional information that could help us confidently say someone with an elevated PSA does not need a biopsy.”
Dr. Nyame will also present evidence to support the benefit of screening the high-risk population starting at age 40 to 45 and stopping screening earlier, when life expectancy is less than 10 years. “Simply screening at an earlier age and stopping earlier can also create a risk-to-benefit screening ratio that can be favorable,” he said.
